Questions like “where are you from?” or “what language do you speak?” could seem non-threatening, but to some, this could feel stigmatizing and offensive. This was a crucial lesson that public health officials in San Francisco learned during the COVID-19 pandemic. The pandemic put a spotlight on the health disparities that existed for so many people. But in San Francisco, the impact was even more evident for Latinos and Indigenous populations trying to access health information.

In 2021, Latinos averaged 40% of positive COVID cases, while they were only 15% of the city’s population. The economic shutdown, which led to job losses, exacerbated the disparities. A city known for its diversity and culture discovered something critical during the pandemic: language access is crucial for sharing public health information. Further, acknowledging there are different Indigenous languages within the Latino community can make an enormous difference in translating life-saving health information for countless people.

“In general, we were able to start a landscape of who is in our communities and where they were from to help us determine the best way of asking questions and approaching people,” said Abraham Gonzalez with Promotoras Activas SF. This cooperative agreement organization connects residents to services through established relationships with local organizations and city departments. “This information we learned helped us make the needed changes in how we approached the communities.”

By participating in the Public Health Regenerative Leadership Synergy (PHEARLESS) initiative, Mission Economic Development Agency (MEDA), Instituto Familiar de la Raza Inc. (IFR), and the San Francisco Department of Public Health (SFDPH) were able to build on this key learning and continue the momentum. Their successful collaboration during the pandemic was the driver, but their aspirations to do more for the Latino populations meant modifying their approach to working together and improving their leadership.

“As we were coming out of the pandemic, we were working with other organizations to see how we could continue this important work,” said Isela Ford, director of equity community engagement, San Francisco Department of Public Health. “Through PHEARLESS, we wanted to build on our authentic partnerships to ensure we were not only sharing resources but also building our leadership skills by working together.”

MEDA, an organization with a mission to advance a national equity movement by building prosperity, community ownership and civic power; IFR, which works to promote and enhance the health and well-being of the Chicano, Latino, Indígena communities in San Francisco; and SFDPH were ideal partners. They had the experience working together during the pandemic to support Latino populations in emergency circumstances, but a post-pandemic world presented other challenges that needed to be addressed.

With a strengthened commitment to language access, Ford, Jenny Chacon, deputy director, Office of Health Equity at SFDPH, Gonzalez and Francisco Icala of IFR, wanted to use what they learned to address overdose prevention. In addition, given that overdose stigma was even deeper within the Latino and Indigenous populations, they were able to share information and learn from each other to recognize cultural sensitivities.

“We have never focused on identifying the unique demographic and linguistic needs to help inform our approach to health disparities and overdose prevention in these populations,” said Chacon.  “Collecting this information requires the ability to develop trust within these historically stigmatized communities, not only in the United States but also in their homelands in Latin America. Otherwise, these communities aren’t going to open up to you and disclose that they identify as indigenous instead of Latino.”

“I believe the PHEARLESS initiative is profoundly important because it serves as a valuable tool for many emerging leaders who are looking to grow and develop. It provides essential resources and support that can significantly contribute to their journey,” said Icala.